Información del artículo
La dislipemia diabética se caracteriza por unas concentraciones de colesterol unido a lipoproteínas de baja densidad (cLDL) normales, hipertrigliceridemia, valores de colesterol unido a lipoproteínas de alta densidad (cHDL) bajos e hiperapolipoproteína B y partículas LDL pequeñas y densas. Es una de las principales causas de que el riesgo cardiovascular en los sujetos con diabetes mellitus tipo 2 sea equiparable al de los sujetos no diabéticos que ya han presentado un evento coronario. Los objetivos terapéuticos son los propuestos para la prevención secundaria e incluyen cLDL<2,59mmol/l y colesterol no HDL<3,4mmol/l. Las medidas terapéuticas deben instaurarse de forma escalonada, iniciándose con los cambios en el estilo de vida incluida la reducción del peso, y la optimización del control glucémico con agentes orales o insulina. Cuando estas medidas terapéuticas no permiten alcanzar los objetivos propuestos deberá indicarse un fármaco hipolipemiante. Los fármacos de primera elección son las estatinas y los fibratos, dependiendo de las alteraciones lipídicas. Como fármacos de segunda línea se incluyen las resinas y la ezetimiba, en terapia combinada con las estatinas. En los pacientes con hiperlipemia mixta, con frecuencia es necesario utilizar la combinación estatina-fibrato y, en el futuro, la combinación ezetimiba-fibrato puede ser una alternativa en algunos pacientes.
Palabras clave:
Diabetes tipo 2
Dislipemia
Control glucémico
Dieta
Agentes orales
Hipolipemiantes
Diabetic dyslipidemia is characterized by normal concentrations of low-density lipoprotein (LDL)-cholesterol, hypertriglyceridemia, low levels of high-density lipoprotein (HDL)-cholesterol, hyperapolipoprotein B, and small, dense LDL particles and is one of the main reasons why cardiovascular risk in individuals with type 2 diabetes mellitus is similar to that of nondiabetic individuals who have already suffered a coronary event. The therapeutic objectives are those proposed for secondary prevention and include LDL-cholesterol<2.59mmol/l and non-HDL cholesterol<3.4mmol/l. Therapeutic measures should be introduced gradually, beginning with changes in lifestyle, including weight loss and optimization of glycemic control with oral agents and insulin. When these therapeutic measures do not achieve the proposed objectives, a lipidlowering drug is indicated. The first line drugs are the statins and fibrates, depending on the lipid alterations. Second line drugs include resins and ezetimibe in combination with statins. In patients with mixed hyperlipidemia the combination of statin-fibrate and, in the future, the combination of fibrate-ezetimibe could be an alternative in some patients.
Key words:
Diabetes type 2
Dyslipidemia
Glycemic control
Diet
Oral agents
Lipid lowering drugs
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